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ZusammenfassungLokalisierte, solitäre fibröse Tumoren sind eine seltene Entität und finden sich meist im Thorax, können aber auch in Leber, Haut, Meningen, am Peritoneum und Perikard auftreten. Aufgrund des vielgestaltigen mikromorphologischen Erscheinungsbildes ist die Sicherung der Diagnose oftmals schwierig. Entscheidend ist die histopathologische Begutachtung mit differenzierter Immunhistochemie. Die chirurgische Resektion der lokalisierten, solitären fibrösen Tumoren ist die Therapie der Wahl. Die Rezidiv- und Metastasenrate ist abhängig von der histologischen Dignität insgesamt sehr gering. Kontinuierliche Nachsorgeuntersuchungen sind indiziert.Wir berichten über eine 76-jährigen Patientin mit einem monströsen solitären fibrösen Tumor der Pleura, die seit einigen Wochen über Belastungsdyspnoe und stechende Schmerzen rechts thorakal klagte. Computertomografisch zeigte sich eine heterogene Raumforderung mit ca. 22 cm Durchmesser im Mittel- und Unterfeld des Thorax mit Kompression des Zwerchfells und des Mediastinums. Der Tumor wurde über eine doppelte Thorakotomie im 5. und im 8. Interkostalraum vollständig reseziert. Intraoperativ zeigte sich der Tumor zum Mittellappen gestielt. Um den Tumor vollständig zu entfernen, wurde zusätzlich eine Keilresektion aus dem Mittellappen durchgeführt. Der Tumor wog 2,4 kg. Die Diagnose eines solitären fibrösen Tumors der Pleura wurde histologisch und immunhistochemisch gestellt. Postoperativ hat sich die Lunge vollständig entfaltet. Bei der 3-monatigen Nachuntersuchung zeigte sich kein Nachweis eines Rezidivs. Die klinische Symptomatik, Diagnosestellung, Therapieoptionen, Rezidivrisiko und die Prognose dieser Tumore werden aufgezeigt und entsprechend der Literatur diskutiert.

Zusammenfassung Hintergrund Es existieren zahlreiche Publikationen, aus denen hervorgeht, dass in der operativen Therapie des nicht kleinzelligen Lungenkarzinoms durch einen minimalinvasiven Zugang vergleichbare onkologische Resektionsergebnisse erzielt werden wie nach einer Thorakotomie. Herausgearbeitet wurde außerdem, dass ein minimalinvasiver Zugang mit geringeren postoperativen Komplikationen und einem kürzeren Krankenhausaufenthalt einhergeht. Ungeklärt ist jedoch bisher, ob die Wahl des operativen Zugangs mit einem Unterschied in der gesundheitsbezogenen Lebensqualität assoziiert ist. Material und Methoden Aus dem Patientenkollektiv unseres von der Deutschen Krebsgesellschaft (DKG) zertifizierten Lungenkrebszentrums wurden 327 Patienten befragt, die zwischen 2010 und 2017 operiert wurden. Ausgehend von insgesamt 456 verwertbaren Short-Form-12-Fragebögen wurden standardisierte Kenngrößen für das subjektiv empfundene physische und psychische Wohlbefinden gebildet. Diese wurden zunächst zu Kenngrößen der deutschen Normbevölkerung in Relation gesetzt, bevor eine Gegenüberstellung der Lebensqualität von Patienten nach anterolateraler Thorakotomie mit denen von Patienten nach einer videoassistierten Thorakoskopie erfolgte. Ergebnisse Mit einigen Limitationen konnte herausgearbeitet werden, dass die körperliche Dimension der postoperativen Lebensqualität von Patienten mit einem nicht kleinzelligen Lungenkarzinom langfristig eingeschränkt bleibt, während die psychische Dimension nicht relevant eingeschränkt ist. Hierbei ist die Wahl eines minimalinvasiven Zugangs postoperativ nicht mit einer höheren gesundheitsbezogenen Lebensqualität assoziiert. Schlussfolgerungen Unter dem Aspekt der gesundheitsbezogenen Lebensqualität scheinen beide Zugangswege gleichwertig. Der Trend in der Entwicklung sowohl der körperlichen als auch der psychischen Dimension der Lebensqualität nach videoassistierter Thorakoskopie deutet jedoch einen längerfristigen Vorteil des minimalinvasiven Zugangs an.

The treatment of pain after thoracic surgery is a challenge and takes place in the individual clinics mostly according to clinic internal standards. It exists no currently valid S3 guideline for the treatment of acute perioperative and posttraumatic pain. For an effective pain treatment as well individual pain experience as the pain intensity of the various thoracic surgical procedures must be considered. Regular pain assessment with appropriate methods and their documentation form the basis for adequate and adapted pain therapy.There are a number of different pain therapy methods, non-medicamentous and drug-based methods, whose effectiveness is described in the literature partially different. For the treatment of acute postoperative pain after thoracic surgery, mainly drug-related procedures are used, except for physiotherapy as a non-medicamentous method. Increasingly, alternative procedures for the peridural catheter as a therapeutic gold standard in the treatment of pain after thoracic surgery are used. Their application can be integrated into a therapeutic algorithm.

Background/Objective: Inefficient nursing care of chest drains may associated with unacceptable and sometimes life-threatening complications. This report aims to ascertain the level of knowledge of care of chest drains among nurses working in wards in a teaching hospital in Nigeria. Methods: A cross-sectional study among nurses at teaching hospital using pretested self-administered questionnaires. Results: The majority were respondents aged between 31 and 40 years (45.4%) and those who have nursing experience between 6 and 10 years. Only 37 respondents (26.2%) had a good knowledge of nursing care of chest drains. Knowledge was relatively higher among nurses who cared for chest drains daily, nurses who have a work experience of 0.05). Performance was poor on the questions on position of drainage system were not statistically significant with relationship to waist level while mobilizing the patient, application of suction to chest drains, daily changing of dressing over chest drain insertion site, milking of tubes and drainage system with dependent loop. Conclusion: The knowledge of care of chest drains among nurses is poor, especially in the key post procedural care. There is an urgent need to train them so as to improve the nursing care of patients managed with chest drains.

Immer mehr Frauen erkranken an Lungenkrebs. Im Vergleich zu erkrankten Mannern sind sie junger und haufiger Nieraucher, auch finden sich bei ihnen haufiger Adenokarzinome. Ihre Prognose scheint nach chirurgischer Therapie im fruhen Tumorstadium besser als bei Mannern zu sein. Da bei Frauen haufiger fur das Tumorwachstum masgebliche Treibergene gefunden werden, die Angriffspunkte fur zielgerichtete Medikamente sein konnen, ist ein groserer therapeutischer Erfolg durch zielgerichtete stratifizierte medikamentose Behandlungen bei ihnen moglich. Ziel dieser Ubersicht ist die Darstellung einiger genderspezifischer Unterschiede bei Diagnostik und Therapie von Lungenkrebs.

Die vorliegenden Untersuchungen aus verschiedenen Weiterbildungssystemen zeigen, dass die chirurgische Weiterbildung ein relevanter Kostenfaktor fur den Krankenhaustrager ist. Kosten entstehen insbesondere durch verlangerte Operationszeiten mit Bindung des im OP beschaftigten Personals, aber auch eine im Vergleich zum Facharzt geringere Effizienz des Berufsanfangers auf Station. Demgegenuber stehen Einsparungen des Krankenhaustragers durch die tariflich festgelegte geringere Vergutung des chirurgischen Assistenten wahrend seiner Weiterbildungszeit. Der Umfang einer moglichen Finanzierung ist schwer zu ermitteln, da Weiterbildung als „training on the job“ stattfindet und deshalb aus betriebswirtschaftlicher Sicht die Produkte Patientenversorgung und Weiterbildung (sog. Kuppelproduktion) nur bedingt voneinander zu trennen sind. Fur das deutsche Weiterbildungssystem gibt es keine validen Analysen zu den tatsachlichen Kosten. Gegenwartig wird die Weiterbildung indirekt durch die Krankenkassen uber das DRG-System finanziert. Mogliche Modelle einer Finanzierung sind die Bereitstellung von zusatzlichen Mitteln aus dem Gesundheitsfond oder eine Umverteilung durch Zu- oder Abschlage der DRG-Pauschalen entsprechend dem prozentualen Anteil an Weiterbildungsassistenten. Stellungnahmen der beteiligten Spitzenverbande zur Problematik der Finanzierung zeigen, wie schwierig eine Kompromisslosung zum gegenwartigen Zeitpunkt zu erzielen ist. Bei dieser kontroversen Debatte sollte aber berucksichtigt werden, dass eine hochwertige Weiterbildung junger Kollegen die entscheidende Grundlage fur ein effizientes Gesundheitssystem und daher eine entsprechende Finanzierung unumganglich ist.

Das Mediastinalemphysem ist ein seltenes Symptom unterschiedlichster Atiologie. Aus nahezu allen Fachbereichen wird dazu publiziert, wenngleich es uberwiegend anekdotische Einzelfallberichte sind. Nur eine Systematik anhand der Atiologie weist den Weg zur richtigen Therapie. Als Leitfaden kann gelten, dass beim spontanen Mediastinalemphysem mit Ausnahme des Boerhaave-Syndroms zuwartendes Verhalten gerechtfertigt ist. Liegt eine pulmonale Ursache wie z. B. Asthma zugrunde, dann reicht in nahezu allen Fallen die kausale Therapie der Grunderkrankung. Das sekundare Mediastinalemphysem erfordert haufiger zusatzlich zur ursachlichen Behandlung eine Ableitung der Luft aus dem Mediastinum. Gangige Methode sind weitlumige Drainagen. Wegen der Seltenheit des Phanomens wird die Frage des Zusammenhangs zwischen Mediastinalemphysem und Mediastinitis offen bleiben. Keine Publikation liefert Daten fur eine prophylaktische Antibiotikatherapie beim spontanen Mediastinalemphysem. Man wird sich wegen der Seltenheit des Symptoms damit abfinden mussen, dass evidenzbasierte Daten zur Therapie nicht zu generieren sind.

More and more women suffer from lung cancer. In comparison to the male patients they are younger and more likely never-smokers. Adenocarcinomas are more frequently in women than in men. Their long-time survival post curative resection in early stage non-small-cell lung cancer is better than in men. Women show frequently more molecular changes: more molecular targets are found. Therefore they might benefit more from target-oriented stratified medical treatments. This overview comments on the gender-specific differences in diagnostics, treatment and outcome of lung cancer.

Zusammenfassung Die invasive pulmonale Aspergillose ist eine potentiell lebensbedrohliche Erkrankung, die durch die Besiedlung der Lunge oder Pleurahohle uberwiegend mit dem Fadenpilz Aspergillus fumigatus hervorgerufen wird. Insbesondere findet sich diese opportunistische Mykose bei immunsupprimierten Patienten, bei Tuberkulose-, AIDS- oder Tumor-Patienten. In vielen Fallen kommt es zu Hamoptoe oder sogar zu lebensgefahrlichen Massenblutungen. Der Stellenwert der Chirurgie bezuglich des Aspergilloms wird herausgestellt, insbesondere ube Zeitpunkt und Indikation von operativen Masnahmen sollte interdisziplinar entschieden werden. In jedem Falle sollte eine Resektion den anatomischen Grenzen folgen um ein Rezidiv sicher zu verhindern. Das Ligamentum pulmonale muss immer gelost werden, um das Aufsteigen der Restlunge in den Apex zu ermoglichen und somit keine intrathorakalen Hohlraume zu hinterlassen. Sollten trotzdem Hohlraume zuruckbleiben, stehen Verfahren wie die Thorakoplastik oder die Muskelplombe mit z. B. Latissimus dorsi oder Pectoralismuskel zur Verfugung. Werden die genannten Masnahmen konsequent durchgefuhrt, lassen sich auch bei schwerkranken Patienten befiedigende Ergebnisse hinsichtlich Mortalitat, Morbiditat und Rezidivhaufigkeit erzielen. Summary Invasive pulmonary aspergillosis is a life-threatening disease, developing from infection mostly by Aspergillus fumigatus. It is an opportunistic infection and occurs mostly in immunosuppressed patients, after tuberculosis, in patients with AIDS or malignomas. The most common symptom and complication is hemoptysis up to massive bleeding. Surgical treatment is obligatory on patients with a pulmonary aspergilloma. Time and form of intervention should be discussed between surgeon and pulmonologist. Resection should follow anatomical borders like lobectomy or pneumectomy. Any remaining intrathoracic cavities should be filled either with remaining lung tissue or with muscle flaps of latissimus or pectoralis muscle or omentum majus. Following these rules, intervention can be performed with reasonable mortality and morbidity rate.

Aspiration of foreign bodies is extremely rare in adults, but it may occur during the course of dental treatment and become a serious problem for the patient. A case of a 77-year old man with chronic cough after dental treatment and unrecognised aspiration of an implant is presented. The implant remained unidentified for three years as an endobronchial foreign body of the lower lobe bronchus. A bronchoscopic removal failed and surgery was indicated for lobectomy of the right lower lobe because of chronic pneumonia. A review of prevention, signs and symptoms, management and documentation of the complications is presented.

BACKGROUND A critical look at the effectiveness of medical procedures and therapies is important with the increasing limitations on resources in health care. METHOD The costs for treatment and the quality of life according to the SF-36 were analyzed in a retrospective health economic study on 65 patients who had undergone surgery for primary non-small-cell lung cancer. RESULTS The mean cost for all patients was 7,169 euro per patient. 38.8 % resulted from surgery, 31.6 % were attached to the preoperative phase on the general ward, 11 % postoperatively to the general ward. Intensive care costs accounted for 18.7 %. The cost of each surgical procedure ranged from 4,634 euro for a pneumonectomy to 8,366 euro for a lobectomy with sleeve resection of the bronchus. The most expensive factors were staff, disposable materials, pathological investigations, and radiology services. There was no difference in these proportions with stage of tumor or the surgical procedures undertaken. Quality of life as assessed by the SF-36 questionnaire ranged from 31.82 (physical functioning) to 75.0 (social functioning) one year after the operation. These scores were lower than for those with other chronic diseases. On average, 4.62 quality-adjusted life years were achieved. The cost per QALY was 1,970 euro. The extent of resection and the tumor staging correlates significantly with the mean cost per QALY. CONCLUSION Thoracic surgery is cost intensive. With increasing staging of the tumor, the cost for treatment increased as with increased operation complexity.

Systemic air embolism is known to rarely complicate blunt chest trauma. However, cerebral infarction caused by air emboli possibly originating from a traumatic pneumatocele has not been previously reported. We report a case of a 46-year-old woman who sustained blunt chest trauma with multiple rib and clavicular fractures, hemothorax and a huge, tense traumatic pneumatocele. She subsequently developed clinical and radiologic features of cerebral infarction. The cerebral infarct is likely to be secondary to cerebral air embolism originating from a traumatic pneumatocele.

Tumors of the diaphragm are rare and caused by there special localisation difficult to diagnose. We describe the case of a 31 year old man with a choristoma of the left diaphragmal crux where the localisation and genesis could only be cleared through lateral thoracotomy. Nor the CT guided puncture or the laparoscopy-although sufficient samples for the pathology could be gained-allowed the right diagnose. The importance of good diagnostic approach to select the right operative procedure-in this case the anterolateral thoracotomy-is described.

A 67-year-old patient with upper gastrointestinal bleeding. HISTORY AND CLINICAL FINDINGS: A 67-year old patient with melaena and anaemia (haemoglobin 4.8 g/dl) for 14 days had been admitted to hospital under suspicion of upper gastrointestinal bleeding. The patient had a history of 2/3 resection of the stomach for recurrent duodenal ulcer and of a right nephrectomie for hypernephroma 18 years ago. There was no abdominal pain on pressure, nor muscular guarding. INVESTIGATIONS: Endoscopy (oesophago-duodenoscopie, coloscopie), radiography (angiography, gastrografin passage) and ultrasound failed to locate the source of bleeding. TREATMENT AND COURSE: After repeated endoscopic attempts to localize the source of bleeding and growing need of transfusions (12 blood-concentrates in 5 days) an exploratory laparotomie was done. Surprisingly a bleeding fistula between the stump of the right renal arteria and duodenum was found. The defects were excised and directly closed. CONCLUSIONS: Secondary aortoduodenal fistula after nephrectomy is rare. If the source of bleeding can't be found, and there is in any doubt an exploratory laparotomy should be done.

Background Patients with diffuse peritonitis show an overall mortality of about 20%, probably caused by the breakdown of local defence mechanisms combined with a systemic outspread of bacteria and toxins, which often results in sepsis syndrome. Design In a prospective, randomized, controlled study 50 patients with diffuse secondary peritonitis were included. Patients in the therapy group were treated with an adjuvant medication consisting of a continuous intravenous infusion of antithrombin III and two intraperitoneal instillations of fresh frozen human donor serum. The aim of the study was the reduction of mortality and incidence of multiple organ failure. Results Mean antithrombin III plasma levels in the therapy group were raised above 140% for 4 days and were significantly higher than in the control group. With the intraperitoneal application of fresh frozen serum and antithrombin III opsonic capacity as well as thrombin, inhibitory activity in the exudate could be significantly elevated over 2 days. The 90-day-mortality rate was 6/26 (23%) in the control group and 6/24 (25%) in the therapy group. Although no improvement of mortality was achieved, a slight but not significant reduction of the severity of the multiple organ failure was seen. Conclusions The chosen therapeutic approach was feasible and showed no side-effects. Yet, neither mortality nor multiple organ failure were significantly improved by the applied short-term adjuvant therapy. Thus, for future trials in severely-ill patients a longer treatment period and/or combinations of antithrombin III with other anti-inflammatory agents should be considered.

Treten im Verlauf einer Tumorerkrankung Lungenrundherde auf, oder stellt man solche bei der Primartumordiagnose fest, dann wird haufig ohne Kenntnis der Dignitat des Lungenherdes die Diagnose einer Lungenmetastase gestellt und dem Primarius entsprechend stadiiert. Oft wird die vermeintliche Lungenmetastase spater aber als benigner Herd oder primares Lungenkarzinom diagnostiziert. Methode: Eine retrospektive Analyse von 70 Patienten, bei denen ein solitarer (45) oder multiple (25) Lungenrundherde via VAT reseziert wurden, ergab folgende Ergebnisse. Resultate: Nur bei 33 Patienten (47,1%) bestatigte sich die Verdachtsdiagnose einer Lungenmetastase. Bei 16 Patienten (22,9%) war der Herd ein Lungenkarzinom, als Zweit-Primartumor. Bei 8 davon manifestierte sich das Bronchialkarzinom synchron mit dem extrapulmonalen Tumor und bei weiteren 8 Patienten war es metachron. Bei den restlichen 21 Patienten (30%) handelte es sich um benigne Lasionen. Schlussfolgerung: Die Lungenrundherde bei bekannter Tumoranamnese mussen durch minimal-invasive Resektion (VATS-Keilresektion) entfernt und histologisch geklart werden. Bei solitaren Lungen-metastasen erreicht man damit nicht nur einen diagnostischen, sondern in viele Fallen einen therapeutischen Effekt.

The present analyses of different surgical training systems show that training of surgical residents significantly contributes to hospital costs. These are predominantly caused by prolonged operation times of residents with increased work load for other staff members in the operating room. In addition, the productivity of surgical residents is less compared to experienced surgeons. On the other hand, hospital managements save money by the lower standard wages paid to the residents. The amount of educational costs is difficult to determine because surgical training takes place as on the job training. Therefore, from an economic point of view, the two products patient care and surgical training are difficult to separate. There are no reliable cost analyses available for the German training system. At present surgical training is indirectly financed by the DRG (diagnosis-related groups) flat rates of the health insurance. Possible options of financing the surgical training are additional funding from the health department or redistribution with supplemental payment for those surgical departments which contribute significantly more to the residents' training. Statements of medical associations, health departments and health insurances demonstrate the difficulty to come to an agreement concerning the finances of the training system. Despite this controversial discussion it should be taken into consideration that there is no alternative to a high quality surgical training as this is the basis for an effective health system.

Invasive pulmonary aspergillosis is a life-threatening disease, developing from infection mostly by Aspergillus fumigatus. It is an opportunistic infection and occurs mostly in immunosuppressed patients, after tuberculosis, in patients with AIDS or malignomas. The most common symptom and complication is hemoptysis up to massive bleeding. Surgical treatment is obligatory on patients with a pulmonary aspergilloma. Time and form of intervention should be discussed between surgeon and pulmonologist. Resection should follow anatomical borders like lobectomy or pneumectomy. Any remaining intrathoracic cavities should be filled either with remaining lung tissue or with muscle flaps of latissimus or pectoralis muscle or omentum majus. Following these rules, intervention can be performed with reasonable mortality and morbidity rate.

Aspiration of foreign bodies is extremely rare in adults, but it may occur during the course of dental treatment and become a serious problem for the patient. A case of a 77-year old man with chronic cough after dental treatment and unrecognised aspiration of an implant is presented. The implant remained unidentified for three years as an endobronchial foreign body of the lower lobe bronchus. A bronchoscopic removal failed and surgery was indicated for lobectomy of the right lower lobe because of chronic pneumonia. A review of prevention, signs and symptoms, management and documentation of the complications is presented.

A 67-year-old patient with upper gastrointestinal bleeding. HISTORY AND CLINICAL FINDINGS: A 67-year old patient with melaena and anaemia (haemoglobin 4.8 g/dl) for 14 days had been admitted to hospital under suspicion of upper gastrointestinal bleeding. The patient had a history of 2/3 resection of the stomach for recurrent duodenal ulcer and of a right nephrectomie for hypernephroma 18 years ago. There was no abdominal pain on pressure, nor muscular guarding. INVESTIGATIONS: Endoscopy (oesophago-duodenoscopie, coloscopie), radiography (angiography, gastrografin passage) and ultrasound failed to locate the source of bleeding. TREATMENT AND COURSE: After repeated endoscopic attempts to localize the source of bleeding and growing need of transfusions (12 blood-concentrates in 5 days) an exploratory laparotomie was done. Surprisingly a bleeding fistula between the stump of the right renal arteria and duodenum was found. The defects were excised and directly closed. CONCLUSIONS: Secondary aortoduodenal fistula after nephrectomy is rare. If the source of bleeding can't be found, and there is in any doubt an exploratory laparotomy should be done.

Tumors of the diaphragm are rare and caused by there special localisation difficult to diagnose. We describe the case of a 31 year old man with a choristoma of the left diaphragmal crux where the localisation and genesis could only be cleared through lateral thoracotomy. Nor the CT guided puncture or the laparoscopy-although sufficient samples for the pathology could be gained-allowed the right diagnose. The importance of good diagnostic approach to select the right operative procedure-in this case the anterolateral thoracotomy-is described.

Background In may 1999 a 57 year old woman presented progressive symmetric arthritis of the hand, fingers and forefoot over a period of more than 6 weeks. Laboratory testing revealed an elevated sedimentation rate, increased C reactive protein levels and secondary signs of inflammation (elevated ferritine, alpha-2-fraction in the serum electrophoreses, etc.). The radiograph showed juxtaarticular osteoporosis without further signs of joint destruction. The x-ray of the chest was normal (performed for reasons of nicotin consumption over years and the intention of methotrexate therapy) without signs of malignancy. Initially the patient was treated as an outpatient. Although the initiated DMARD-therapy with methotrexate was well tolerated at a dose of 15 mg orally per week she was finally admitted to the hospital in December 1999 for reasons of further deteriorating of the arthritis and the general feeling. Symmetrical arthritis and elevated sedimentation rate revealed continuous inflammation. An x-ray control of the hand and feet showed a fine periostal hyperostosis suspective for “osteoarthropathy hypertrophiante pneumonique Pierre Marie Bamberger”. The x-ray of the chest was suspective for a malignant process of the lung, a diagnose that was confirmed by computer tomography. Histological examination revealed an adeno carcinoma of the lung. Consecutive palliative chemotherapy led to improvement of arthritis. Objectives ./. Methods ./. Results ./. Conclusion This is a case of malignant lung disease with the rare initial symptom of symmetric progressive arthritis and periostal hyperostosis, improving after chemotherapy.

Patients with diffuse peritonitis show an overall mortality of about 20%, probably caused by the breakdown of local defence mechanisms combined with a systemic outspread of bacteria and toxins, which often results in sepsis syndrome.In a prospective, randomized, controlled study 50 patients with diffuse secondary peritonitis were included. Patients in the therapy group were treated with an adjuvant medication consisting of a continuous intravenous infusion of antithrombin III and two intraperitoneal instillations of fresh frozen human donor serum. The aim of the study was the reduction of mortality and incidence of multiple organ failure.Mean antithrombin III plasma levels in the therapy group were raised above 140% for 4 days and were significantly higher than in the control group. With the intraperitoneal application of fresh frozen serum and antithrombin III opsonic capacity as well as thrombin, inhibitory activity in the exudate could be significantly elevated over 2 days. The 90-day-mortality rate was 6/26 (23%) in the control group and 6/24 (25%) in the therapy group. Although no improvement of mortality was achieved, a slight but not significant reduction of the severity of the multiple organ failure was seen.The chosen therapeutic approach was feasible and showed no side-effects. Yet, neither mortality nor multiple organ failure were significantly improved by the applied short-term adjuvant therapy. Thus, for future trials in severely-ill patients a longer treatment period and/or combinations of antithrombin III with other anti-inflammatory agents should be considered.

In einer prospektiven randomisierten kontrollierten Studie an Patienten mit diffuser sekundarer Peritonitis wurden die stationaren Behandlungskosten analysiert (n = 36, Kontrollgruppe n= 19, Therapiegruppe n= 17). Die Therapiegruppe erhielt zur Standardtherapie eine postoperative viertagige adjuvante Therapie mit Antithrombin III i.v. auf 140% der Norm, und 2 Einheiten fresh-frozen-Serum intraperitoneal. Gesamtkosten der Behandlung: O 43510,- DM pro Patient (Kontrolle: O 49616,- DM, Therapie: O 36683,- DM zuzuglich O 10082,- DM fur AT III). 82% der Kosten entfallen auf die ICU (O 36047,- DM). Die Personal- (O 28,9%), Medikamenten- (O 21,9%) und Blutproduktekosten (O 13,6%) sind die grosten Einzelposten. Die Therapiegruppe ist durch kurzere Intensiv-Hamofiltrations- und Beatmungszeiten, niedrige OP-Kosten sowie Medikamenten- und Blutproduktebedarf preiswerter. Die adjuvante AT-III-Gabe verteuert damit die Behandlung nicht.